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Version 1- 01/10/10
In Association With
Learning work book to contribute to the
achievement of the underpinning
knowledge for unit: ASM 34
Administer Medication to
Individuals and Monitor the
Effects
Credit value 5
All rights reserved, no parts of this publication may be
reproduced, copied, stored or transmitted without the prior
permission of
The Learning Company Ltd
© The Learning Company Ltd
Q C F A C D H & S C L 3 L i c e n s e d u n t i l F e b 1 2 U n i t A S M 3 4
Page 2
Learner’s Name:
Learner’s Signature:
(Please sign inside the box)
Employer’s Name:
Employer’s Address:
Start Date:
Anticipated End Date:
College Provider:
Learner’s Enrolment Number:
Mentor’s Name:
Assessor’s Name:
Internal Verifier’s Name:
I V’s Sampling Date:
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Q C F A C D H & S C L 3 L i c e n s e d u n t i l F e b 1 2 U n i t A S M 3 4 Page 3
INTRODUCTION
This workbook provides the learning you need to help you to achieve a unit towards your qualification. Your qualification on the Qualification and Credit Framework (QCF) is made up of units, each
with their own credit value; some units might be worth 3 credits, some might have 6 credits, and so on. Each credit represents 10 hours of learning and so gives you an idea of how long the unit will take to achieve. Qualification rules state how many credits you need to achieve and at what levels, but your assessor or tutor will help you with this.
Awarding Organisation rules state that you need to gather evidence from a range of sources. This means that, in addition to completing
this workbook, you should also find other ways to gather evidence for your tutor/assessor such as observed activity; again, your
assessor will help you to plan this.
To pass your qualification, you need to achieve all of the learning outcomes and/or performance criteria for each unit. Your qualification may contain essential units and optional units. You’ll
need to complete a certain amount of units with the correct credit value to achieve your
qualification. Your tutor/assessor can talk to you more about this if you’re worried and they’ll let you know how you’re doing as you
progress. This workbook has been provided to your learning provider under
licence by The Learning Company Ltd; your training provider is responsible for assessing this qualification. Both your provider and
your Awarding Organisation are then responsible for validating it.
THE STUDY PROGRAMME This unit is designed for individuals who are working in or wish to pursue a career in their chosen sector. It will provide a valuable,
detailed and informative insight into that sector and is an interesting and enjoyable way to learn. Your study programme will increase your knowledge, understanding and abilities in your industry and help you to become more
confident, by underpinning any practical experience you may have with sound theoretical knowledge.
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Q C F A C D H & S C L 3 L i c e n s e d u n t i l F e b 1 2 U n i t A S M 3 4 Page 4
WHERE TO STUDY The best way to complete this workbook is on your computer. That way you can
type in your responses to each activity and go back and change it if you want to. Remember, you can study at home, work, your local library or wherever you
have access to the internet. You can also print out this workbook and read through
it in paper form if you prefer. If you choose to do this, you’ll have to type up your answers onto the version saved on your computer before you send it to your tutor/assessor (or handwrite them and post the pages).
WHEN TO STUDY It’s best to study when you know you have time to yourself. Your tutor/assessor will help you to set some realistic targets for you to
finish each unit, so you don’t have to worry about rushing anything. Your tutor/assessor will also let you know when they’ll next be
visiting or assessing you. It’s really important that you stick to the
deadlines you’ve agreed so that you can achieve your qualification on time.
HOW TO STUDY Your tutor/assessor will agree with you the
order for the workbooks to be completed; this should match up with the other
assessments you are having. Your tutor/assessor will discuss each workbook with you before you start working on it,
they will explain the book’s content and how they will assess your workbook once you have completed it. Your Assessor will also advise you of the sort of evidence they will be expecting from you and how this will map to the knowledge and understanding of your chosen qualification. You may also have a mentor appointed to you. This will normally be a line manager who
can support you in your tutor/assessor’s absence; they will also confirm and sign off your evidence.
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Q C F A C D H & S C L 3 L i c e n s e d u n t i l F e b 1 2 U n i t A S M 3 4 Page 5
You should be happy that you have enough information, advice and
guidance from your tutor/assessor before beginning a workbook. If you are experienced within your job and familiar with the
qualification process, your tutor/assessor may agree that you can attempt workbooks without the detailed information, advice and guidance.
THE UNITS We’ll start by introducing the unit and clearly explaining the
learning outcomes you’ll have achieved by the end of the unit. There is a learner details page at the front of each workbook. Please ensure you fill all of the details in
as this will help when your workbooks go through
the verification process and ensure that they are returned to you safely. If you do not have all of the
information, e.g. your learner number, ask your tutor/assessor. To begin with, just read through the workbook. You’ll come across different activities for you to try. These activities won’t count
towards your qualification but they’ll help you to check your learning. You’ll also see small sections of text called “did you know?” These
are short, interesting facts to keep you interested and to help you enjoy the workbook and your learning.
At the end of this workbook you’ll find a section called ‘assessments’. This section is for you to fill in so that you can prove
you’ve got the knowledge and evidence for your chosen qualification. They’re designed to assess your learning, knowledge and understanding of the unit and will prove that you can complete all of the learning outcomes.
Each Unit should take you about 3 to 4 hours to complete,
although some will take longer than others. The important
thing is that you understand, learn and work at your own
pace.
YOU WILL RECEIVE HELP AND SUPPORT If you find that you need a bit of help and guidance with your learning, then please get in touch with your tutor/assessor. If you know anyone else doing the same programme as you, then
you might find it very useful to talk to them too.
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Certification When you complete your workbook, your tutor/assessor will check your work. They will then sign off each unit before you move on to the next one.
When you’ve completed all of the required workbooks
and associated evidence for each unit, your assessor will submit your work to the Internal Verifier for
validation. If it is validated, your training provider will then apply for your certificate. Your centre will send your certificate to you when
they receive it from your awarding organisation. Your tutor/assessor will be able to tell you how long this might take.
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Q C F A C D H & S C L 3 L i c e n s e d u n t i l F e b 1 2 U n i t A S M 3 4 Page 7
Unit ASM 34: Administer medication to individuals, and
monitor the effects
About this unit
This unit is for those who prepare for, administer and monitor the effects of medication on individuals. The unit applies to all medication used for and by individuals, both prescribed and non-prescribed.
Learning outcomes
There are five learning outcomes to this unit. The learner will be
able to:
1. Understand legislation, policy and procedures relevant to administration of medication 2. Know about common types of medication and their use
3. Understand procedures and techniques for the administration of medication
4. Prepare for the administration of medication
5. Administer and monitor individuals’ medication
Legislation governing the administration of medication
All aspects of health and safety are covered by legislation. The administration of medication is no exception. The handling and use of medicines, drugs and poisons is governed by a series of Acts and Regulations of Parliament.
In Great Britain, two types of law apply to aspects
of health and safety in the workplace; these are Civil Law and Statute Law.
Civil Law - Claims can be made in civil courts for
damages (financial compensation) if harm, injury or damage has been caused due to the negligence of someone who owed a duty of care to the injured party.
Statute Law – health and safety at work legislation forms part of criminal law and therefore must be obeyed. Breaches of legislation can result in a criminal court imposing fines or imprisonment, on
companies, organisations or individuals.
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The framework of this legislation is based on Acts of Parliament,
which usually impose broad general duties. Regulations are then made under the relevant Acts, to cover detailed health and safety
requirements that are to be observed. The majority of recent Regulations were made under
the Health & Safety At Work etc. Act 1974
Approved Codes of Practice - these are codes of practice approved by the Health and Safety
commission, and can supplement Acts and Regulations by giving guidance on the requirements
set out in the legislation
H & S Legislation The principal Act of Parliament regarding workplace Health and
Safety is the Health and Safety at Work, etc. Act 1974. It is important that the following main provisions of HASAWA are fully appreciated:
� The Act applies to all people “at work” (with a few minor
exceptions such as domestic servants) whether they are employees or self-employed. Trainees are regarded as
employees under the Act. � Employers have a duty, so far as is reasonably
practicable, to ensure the health, safety and welfare of their employees and any others who might be affected by
their activities, e.g. members of the public. � Self-employed persons have a duty to conduct their
business in such a way as to ensure their safety and the safety of others who may be affected by their activities.
� Employees have a duty to co-operate with their employer and to take reasonable care for the health and safety of
him or herself and of others who may be affected by his or her activities at work.
� and carried out in a safe manner
The Control of Substance Hazardous to Health (COSHH)
Regulations
COSHH Regulations of 1988 consolidated in 1994,
amended in 1996, 1997and 1998, 1999 and further consolidated in 2002 are the main piece of legislation
covering control of the risks to employees and other people arising from exposure to harmful substances generated out of or in connection with any work activity under the employer's control.
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The main objective of the Regulations is to reduce occupational ill
health by setting out a simple framework for controlling hazardous substances in the workplace.
As with all other regulations building on the Health and Safety at Work etc. Act, legal duties under COSHH are laid primarily on
employers and it is their duty to see that proper systems of work and management are in place. In higher education, the "employer" is taken to be the governing body of the University e.g. the University
Council. Many of the duties that employers owe to their employees extend to non-employees, such as
students, who may be affected by the employer's activity.
Duties on employees include making proper use of any control measures, following safe systems of work, abiding by local rules
and reporting defects in safety equipment. Non-employees have no specific duties under COSHH but the requirements of the Health and Safety at Work etc. Act do apply, forbidding the misuse of anything provided in the interests of health, safety or welfare.
Complying with COSHH involves:
� Assessing the risks to health arising from hazardous substances at work and deciding what precautions are needed,
� Preventing or adequately controlling exposure, � Ensuring that control measures are used, maintained,
examined and tested,
� If necessary, monitoring exposure and carrying out health surveillance and
� Ensuring that employees are properly informed, trained and supervised.
The Misuse of Drugs Act 1971:
The Misuse of Drugs Act (MDA) is the major act controlling drugs. It places controlled drugs into one of three
classifications (A, B or C), depending on how dangerous the drug is thought to be at the time of inclusion - those drugs thought to be most
dangerous are Class A. There is no clear protocol that says what 'dangerous' effects warrant these
classifications, and it is therefore not possible to say that the toxicity, likelihood of dependence, or psychoactive effects of Class A drugs is vastly different to those drugs in Class C.
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Drugs are also placed within one of five schedules (1-5). The
Schedule that a drug is placed in relates to its perceived medical therapeutic use. Schedules determine whether a drug may be
prescribed or not, and impose duties relating to record keeping, manufacturing, storage and distribution. Schedule 1 drugs are thought to have no legitimate medical
therapeutic use, and possession is only legitimate with a home office licence; many schedule 5 drugs are sold without the need for a prescription.
Drug Offences: The drug offence that most people will be aware of is possession. If
you have controlled drugs in your physical possession or have control of them and are not entitled to do so then you could be
charged with this offence. Common types of possession are simple possession - you are knowingly in possession of a controlled drug,
joint possession - you own a pool of drugs jointly with other people, and past possession - you have previously been in possession of a controlled drug. Supply of a drug is a far more serious offence. If you pass drugs to another person you are supplying them with that
substance, whether or not money is involved. Sometimes a charge of possession with intent to supply is brought because of an admission by the person involved, or because the amount of the
drug involved is too large to be for personal use only. If you knowingly allow other people to use premises that you occupy in order to produce or supply drugs you are committing an offence. Restrictions about drug use on premises that you occupy relate only
to opium or cannabis; if you were aware that someone was injecting heroin you would be under no legal obligation to stop them, but you
are obliged to stop the consumption of cannabis. The Medicines Act 1968
The Medicines Act 1968 regulates drugs that are used for medicinal
purposes, and again there are three main categories. A pharmacist can only sell 'Prescription Only' drugs, but only if they have been prescribed by a doctor. The 'General' category allows the medicines to be sold without a prescription in any
shop, and a pharmacist can sell 'Pharmacy Medicines', without the need for a prescription. Possession of 'Prescription Only' medicines without a prescription is
a serious offence. Drugs such as amyl nitrite, GHB and ketamine are regulated under the Medicines Act.
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Misuse of Drugs Regulations 1985
Defines who may produce, possess, supply, prescribe and
administer certain drugs. Schedule 1: Prohibited except with Home Office authority E.g. cannabis, LSD, raw opium, Ecstasy Schedule 2: Controlled drug Specific requirements for prescribing, safe custody, registering
e.g. diamorphine (heroin), pethidine, cocaine, amphetamine Schedule 3: Barbiturates, Pentazocine
Schedule 4: Benzodiazepines Schedule 5: Preparations containing small amounts of controlled
drugs e.g. Co-proxamol, Co-codamol
Infection control.
Hygiene is an important safety factor when working closely with individuals. Standards precautions and procedures for washing
hands and maintaining your own good standards of hygiene must be followed. This is vital when using the non-touch technique to administer medication.
Effective hand washing.
� Begin by removing your rings. Push your watch up on your
arm or remove it. This will allow for thorough cleaning and drying.
� Adjust the water to comfortably warm temperature and rinse your hands from the wrist downward.
� Apply soap either liquid or use a clean bar of soap (be sure it has a place to drain such as on a rack).
� Lather thoroughly. � Begin at your wrist and work downward. � Interlace your fingers and thumbs and
continue scrubbing by sliding your fingers
back and forth. Clean under your nails and around the nailbeads as well.
� 15-30 seconds of vigorous scrubbing will
eliminate most transient bacteria. ("Scrubbing" for surgery or other procedures requires at least 2 minutes)
� Then rinse your hands thoroughly from the wrist downward. � Dry your hands thoroughly. Paper towel is suggested.
Otherwise, fresh or disposable towels should be provided for personal use.
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� Use the towel (preferably a dry section) to turn off the water
and protect your hands from recontamination.
Effective Hand Hygiene
Preparing and checking medication
Nurses and care staff are taught the five rights as a means of minimizing opportunities for errors. The five R's are: THE RIGHT
MEDICATION IN THE RIGHT DOSE, TO THE RIGHT PATIENT
BY THE RIGHT ROUTE AT THE RIGHT TIME. There are opportunities for errors even when complying with the five Rs.
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Administration of the wrong drug is the most common error that
occurs. Factors that contribute to wrong drug error include similar labeling and packaging of products, medications with very similar
names and storage of these similar products together. In addition, poor communication is a common
cause of administering the wrong drug. When transcribing verbal orders or verifying transcription of orders, a few simple precautions can help avoid errors:
� Always repeat verbal orders
� Avoid using dosage and product abbreviations � Never assume ROUTE of administration
� Never use trailing zeros (write 25 not 25.0) � Never try to decipher illegible orders
� When in doubt, always check with the prescriber, pharmacist or literature
Always check the drug label and dose against the doctor's order
three times prior to administration
Do not administer any drug if you are unsure of its intended use
Many medications can be administered by a variety of routes, such as oral, rectal, intravenous, subcutaneous, intramuscular, or sublingual. The route selected by the prescriber depends on the
patient's condition and the speed with which the therapeutic effect will need to occur.
The prescribed dosage is based on the route by which the drug is given. In general, oral dosages are greater than injected dosages for the same drug. Errors can
occur when a dose intended for oral administration is given by injection. For example, 30 mg dose of Morphine Sulfate mistakenly given IV rather than orally could potentially result in respiratory arrest and
death. In today's hectic health care environment, it is
especially important to confirm an individual's identity prior to conducting any procedure. Many carers float between settings,
work part-time or work in ambulatory settings where large numbers of individuals are in and out during the day. These situations increase the probability of giving medication to the wrong person.
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It is imperative to check every individual's ID bracelet, if they have
one, prior to giving a medication. Always confirm their name, age and allergies, and ask them to state their name.
While it is important to utilize the five rights when administering medications, care responsibilities
related to drug therapy require an extensive knowledge of pharmacology and how the care process assists the practitioner in ensuring that each patient achieves the best possible outcome from his drug
regimen. You are often the first health care provider to identify signs and symptoms that may require drug therapy or may signal
an adverse outcome from ongoing therapy.
What can you do to minimise the opportunity for error?
� Ensure that information relating to individuals is current and available consistently to all health care providers.
� Include information such as age, weight, height (as needed to calculate body surface area), date of birth and known
allergies. � Know the treatment plan and the prognosis. � Ensure that the drug information is current and readily
available. � Know the indications and appropriate dosing for the
medication prescribed. If you are not sure, look it up or call the pharmacy.
� Know the precautions and contraindications. � Know the expected outcomes after the use of the medication.
� Know about potential adverse reactions. � Know the drug/drug and drug/food interactions. � Know how to minimize the effects of an adverse reaction. � Know how the drug should be administered and stored.
� Have pharmacy identify a patient's own medications and provide drug fact sheets prior to medication administration.
DID YOU KNOW?
The first video aired on MTV was “Video
Killed the Radio Star” by the Buggles in 1981.
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ACTIVITY ONE
Circle the words or phrases you would associate with
reducing errors
Candy floss Current Information
Plan Hot dog Identify
Know Outcomes Toffee apple
Each medicine container should be labelled and show the:
� Date of supply � Name and form (tablet, capsule etc), quantity and strength of
medicine � Dosage and timings and how the medicine
should be administered � Name of the individual it is for
� Name and address of pharmacy and prescribing GP
Some of the most commonly used medications.
� Angiotensin converting enzyme (ACE) inhibitors are a group of drug originally developed to lower high blood pressure.
� Antacids and alginates Antacids are taken to treat dyspepsia - better known as
indigestion or heartburn. A number of antacids and related remedies are available without prescription from pharmacies and supermarkets, although these should still be considered to be medicines.
� Antibiotics Antibiotics, sometimes known as antibacterials,
are drugs used to treat infections caused by
bacteria (the plural of bacterium). � Antidepressants
As their name suggests, antidepressants are used to treat depression. There are many types of antidepressant. Here we will discuss the two most commonly used - tricyclic drugs such as amitriptiline (Lentizol) and imipramine (Tofranil) and
selective serotonin re-uptake inhibitors (SSRIs) such as fluoxetine (Prozac).
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� Antihistamines
Antihistamines are most commonly found in medicines for allergic conditions like hay fever
and also in some cough and cold remedies, some preparations for sickness and some migraine treatments.
� Benzodiazepines This group of drugs are also known as minor tranquillisers and sedatives. The best known are probably diazepam (brand name Valium) and nitrazepam (Mogadon).
� Beta2 agonists � This article looks at the medicines used to relieve an asthma
attack - the blue-coloured inhalers containing medicines known as beta2 agonists.
� Beta-blockers Beta-adrenoreceptor blocking drugs, more commonly called
beta-blockers, work on the heart and circulatory system, reducing blood pressure and having other beneficial effects on the heart and circulation.
� Calcium-channel blockers
� These drugs are used to treat problems with the heart and circulatory system including high blood pressure and angina.
� Combined oral contraceptives (COCs)
Often just referred to as 'the pill', combined oral contraceptives (COCs) are one of many methods of preventing pregnancy. The COCs are so called because they combine two types of female hormone, oestrogen and
progestogen. � Eye preparations
There are several different groups of drugs that are included in eye preparations. Here we discuss the four main categories.
� Drugs for glaucoma Glaucoma is a condition in which the
pressure in the eye is too high. There are five main types of drug used in the treatment of glaucoma - miotics, sympathomimetics, beta-blockers, carbonic
anhydrase inhibitors, and latanoprost (Xalatan). � H2 antagonists
There are a number of medicines for treating stomach ulcers
and indigestion. One of the most important of these is a group of medicines known as H2-receptor antagonists or H2
antagonists. � Hormone replacement therapy
Hormone replacement therapy is usually just called HRT. It is recommended to women during and after the menopause, the
end of menstruation.
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� Inhaled steroids Inhaled corticosteroid drugs, or inhaled steroids as they are usually known, are used
to prevent the symptoms of asthma. � Laxatives
There are several types of laxative that all
work in different ways to help relieve or prevent constipation. Here we discuss three of the main types.
� Loop diuretics (e.g. furosemide/frusemide) A diuretic is a type of drug that removes water from the body.
Loop diuretics are a particularly powerful type of diuretic used for treating heart failure.
� Nonsteroidal anti-inflammatory drugs Nonsteroidal anti-inflammatory drugs, more commonly called
NSAIDs (pronounced En-sayds), reduce inflammation and relieve pain. The most widely used NSAID is ibuprofen (e.g.
Brufen, Nurofen). � Paracetamol
Paracetamol is a painkiller, more technically described as a non-opioid analgesic. As a painkiller, it's similar in strength to
aspirin, but does not have the anti-inflammatory action of aspirin.
� Medicines for an enlarged prostate
Benign prostatic hyperplasia (BPH) is a condition in which the prostate gland gradually enlarges. It occurs to some degree in most men from middle age onwards.
� Proton pump inhibitors
Proton pump inhibitors are a family of drugs used to treat stomach ulcers by completely blocking the production of
stomach acid. � Statins
Statins are a relatively new group of drugs used to lower blood cholesterol levels.
� Topical steroids Topical corticosteroids, more commonly called steroid creams, are applied to the skin to relieve eczema and some other skin
conditions. Routes of administration
When administering medicines via any route and in any form, it is
vital that you are fully aware of the needs and abilities of the individuals receiving the medicines. They may be totally independent and able to administer for themselves, or may need full support. Whatever their needs, it is vital that you select and
utilise the most appropriate equipment for their abilities.
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It may be that liquid suspension is taken more easily than tablets,
see if you can request these if they are available. Or a dosset box may help with self administration. You may need to help measure
a liquid therefore a cup measure will be helpful. Oral medication
This is the most common form of medicine, and comes in tablet, capsule, syrup or suspension liquid. Often tablet have a special coating which reacts with the
digestive system to release the drug. If the instructions require medication to be taken with food or
with water, this is usually because it will help the drug work more effectively.
Inhaled medication
These are prescribed for respiratory disorders such as asthma and bronchitis. There are two types of inhaler, the aerosol puff inhaler and the spinhaler. For all inhaled medications the process is the
same. The user needs to breathe out, put the inhaler in their mouth, take a puff and breathe deeply. The dosage is measured in the number of puffs.
Some inhalers are used daily and others as required. In severe cases a nebuliser may be used which pumps air through a chamber containing the drug; this then passes into a face mask worn by the
user.
Eye preparations
Eye drops or ointments may be prescribed. When applying the lower eyelid should be gently pulled downwards and the correct
amount of the preparation inserted under the eyelid. It is important that hands are washed before and after this procedure and clients must be encouraged to do this as well if they are administering the medication.
Nasal preparations
Nasal medication can be drops or sprays. Sprays should be inserted into one nostril while the other
nostril is held closed. Ask the individual to breathe deeply through the nose whilst spraying and then repeat the process for the other nostril. Nasal drops should be administered with the head as far forward as
possible to give the drops the best chance of working.
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This can be done by the person lying on a bed or across a chair with
their head hanging over the edge.
Ear drops
Ear drops are usually supplied in a bottle with
an applicator. The required number of drops should be dropped into the ear. The applicator must never be inserted into the ear as it could cause damage. Unless otherwise
advised, cotton wool should not be put into the ear following administration.
Vaginal and rectal preparations
These will generally always be administered by a care worker as
most clients will not have the mobility and suppleness to administer these themselves. For vaginal preparations, the individual should lie on the bed with
their knees bent and slightly apart. This will ease administration if the individual is able to relax. The best way to administer rectal preparations is for the individual
to lie on one side with their knees drawn up in front of them. Topical preparations
These are ointments and creams and are usually designed for a specific area of the body. Hands should be washed
before and after application. Ointments and creams should not be rubbed in unless this is specified in the instructions. Generally they are intended to be absorbed slowly into the affected areas.
Medication aids
Dosset boxes are simple boxes for pills, with compartments for
particular days of the week and times of day. They help people remember to take their medication at the right time. Simple versions are available from the local chemist. Automatic pill
dispensers are also available. When the medication needs to be taken, the dispenser beeps and a small opening allows access to the
particular pill at the right time. Drug wallets can also help people take the right doses at the right times. Drug wallets usually hold seven small containers to keep medication in (one for each day of the week).
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Each container is divided into sections usually marked morning,
afternoon and evening. The containers can be removed if a person is going out and wants to take their medication with them.
Administering medication using a non-touch technique
Administration of intravenous drugs can often be defined as the introduction of a fixed volume of drug(s) into the cannula, generally already in situ (ready for the introduction of the drug). The aim of this procedure is to ensure that the prescribed drug will be given to the correct patient, at the correct time, in the
correct dose, without any contamination occurring. The principles of asepsis, including hand washing, minimal touch
technique and the cleansing of access points prior to use are essential.
This approach is also utilised for example during the administration and disposal of Cytotoxic medication in the community; enteral feeding, changing, removing or applying dressings, during
nasogastric feeding and for blood transfusions. The following recommendations apply;
� Hands that are visibly soiled or contaminated with dirt or
organic material must be washed with soap and water before using an alcohol hand rub
� Before accessing or dressing a wound or administering medication hands must be cleaned either by washing with
an anti microbial soap and water, or by using an alcohol (70%) hand rub
� An aseptic technique must always be used � Gloves should always be worn when accessing lines for the
prevention of blood borne pathogen exposure, or when administering Cytotoxic medication.
Administering injections
A subcutaneous injection is administered beneath the epidermis into the fat and connective tissue underlying
the dermis. For subcutaneous injections the skin should be gently pinched into a fold to elevate subcutaneous
tissue which lifts the adipose tissue away from the underlying muscle. An intramuscular injection is administered through the epidermis,
dermis, and subcutaneous tissue into the muscle.
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Giving an injection (subcutaneous)-
� Wash your hands.
� Remove the cover, being careful to avoid touching or bending the needle.
� Do not attempt to replace the cover as you may
prick yourself or damage the needle. � There is a small air bubble in the syringe. This
should not be removed and helps to prevent pain and bruising.
� Pinch the skin gently to form a mound. � Push the needle in as far as it will go, with the syringe at a
right angle to the skin. � Inject slowly, holding the mound of skin.
� Gently dab with a tissue or cotton wool if necessary. Do not press or rub as this may cause a painful bruise.
� Dispose of the syringe in the yellow 'sharps box' provided. Side effects
Medication may cause reactions that were not intended. These are known as side effects. Possible side effects are mentioned in the instructions that come with the medication, although the majority
do not last long and are not a serious risk to health. Nobody can predict whether a person will experience side effects, so it is vital for you to inform your Manager and the individual’s GP if
there are any unusual reactions. If this happens, it may be necessary for the individuals to stop taking the medication and try a
different form of treatment. Their GP will be able to advise whether the side effects outweigh the benefits of the medication. Many drugs have side effects, an adverse effect is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as a result of a therapy or other medical intervention, such as drug/chemotherapy, physical
therapy, surgery or medical procedure. Using a drug or other medical intervention which is contraindicated may increase the risk of adverse
effects. Adverse effects may cause medical complications of a disease or procedure and negatively affect its prognosis.
The harmful outcome is usually indicated by some result such as blotchiness of the skin, reddening of the skin, sweating, clamminess, nausea, vomiting or any other change to condition.
The outcome can be fatal in some cases.
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They may cause a reversible or irreversible change, including an
increase or decrease in the susceptibility of the individual to other chemicals, foods, or procedures (e.g. drug interaction).
The possibility of any adverse effects should be explained to the individual taking the medication.
Your role
Your support can be a key factor in ensuring that
individuals are able to manage their medical needs safely and effectively. Through discussion
with the individual you can ascertain the level of support and explanation required when taking
medication. Communication must be at the appropriate level for the individual concerned, and clear explanation around the need
and procedures for taking the medication must be given. Also offer reassurance that you are there to monitor and support them as necessary.
One of the factors you must consider when choosing the best method of communication is the person who is going to receive it. Make sure the method is appropriate for the person who will receive
it. Do not, for example, show the medication and details to a person who is visually impaired unless you know they have a method of having it read or Braille is provided. Do not attempt to pass on information to someone with hearing loss unless they have
a functioning hearing aid and you know it works and always use language which is at the right level for the person receiving the
information. Everything you say and do communicates a message so this must be carefully considered before delivery. Choose your words carefully and take care to manage information according to your setting’s policies and procedures.
Always keep a record of messages you have passed on. Include the date and time and who you passed the message on to. If there are any
disagreements later on, this can be useful in resolving them.
However it is also important not to act beyond your role and responsibilities. For example you must not take the responsibility of
giving alternative medications or doses to individuals. They need to be referred to their GP for this to happen. The results could be further illness or even fatality.
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It is also vital to ensure that the medication has been taken, often it
can be stored in the individual’s mouth and they may spit it out later.
Discussions based around the administration of medicines, according to their route and the level of
privacy required, need to be held in private and not in the hearing of other residents or visitors. The level of privacy when discussing this with individuals may be determined by the setting you work in but you must do your best to
maintain dignity. For example the administration of suppositories or the application of creams may require absolute privacy.
If a person does require assistance, then this must be offered in a
quiet and unobtrusive manner. You must not discuss this loudly in front of others. Key to this is also establishing how an individual
will let you know they wish you to give assistance. They may feel perfectly able to administer their medication on day and not able to do this the next. Will they call or use a bell or buzzer, or simply wait for you to attend at an agreed time?
Privacy must be maintained although some situations may be far from ideal, for example curtains around a hospital bed.
Storage of medication
All medication should be examined for information about storage
conditions and these conditions must be adhered to. All medication, including Homely Remedies, for example Paracetamol, Simple
Linctus and Magnesium Tri-sil, must be stored in a lockable facility in a lockable room, with the key accessible to delegated staff only. The keys should be in the personal possession of identified staff. It is not
appropriate to keep the key in a known location such as a drawer, hook or unlocked key press. In addition there should be a secure area for medication storage and administration. If this is a room it should house a lockable
cabinet, ideally one that cannot be easily removed, a sink, if possible, and a lockable refrigerator. It is also necessary to provide separate storage for internal and external use only medicines. If
controlled drugs are kept on the premises then a Controlled Drugs cupboard must be provided. This cupboard must have a certificate
for its use from the provider, must be of a certain thickness and fixed to a permanent wall. A GP and/or prescribing pharmacist will be able to advise if a drug is a ‘controlled drug’.
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If a drug is/or may be required urgently, e.g. steroid, then it can be
kept in a place for easy access but this must be based on risk and individual circumstances.
The current medication charts or Medication Administration Record sheets (MARS) must also be
kept in the same room for easy access and use. When complete they should be transferred to the case file. If individuals self medicate they must be able to lock their medication away in a drawer or cupboard.
Cupboards must be sited away from sources of heat, moisture or
direct sunlight as any of these elements can cause medicines to deteriorate.
� When not in use, trolleys must be secured to a wall or kept in
a lockable cupboard. � Medicines which are to be swallowed should be kept apart
from external items. � Medication requiring refrigeration should be stored in a
lockable drug fridge. If such a fridge is not available medicines may be stored in a domestic fridge in a locked container labelled "medicines - authorised access only".
� Stock should be rotated as it is received. NEVER mix the remains of an old prescription with a freshly supplied prescription.
� Some medications, e.g. antibiotic suspensions, require
storage in a refrigerator, which should be for medication only and locked – this applies particularly to registered homes and
where possible in other settings.
DID YOU KNOW?
The creator of the NIKE Swoosh symbol was paid only $35 for the design.
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ACTIVITY TWO
Circle the words or phrases you would associate with storing
medication
Dodgems Fridge Locked
Container Helter skelter Trolley
Cupboard Access Wurlitzer Records for administration.
Receipt of Medicines
All medicines brought into the home from whatever source,
including discharge medicines from hospital, medicines prescribed in an acute situation as well as medicines prescribed on a regular on
going basis or those brought from another home should be recorded. Care should be taken to include medicines brought from the individual’s own home or those brought in by friends/relatives.
The record should show:
� Date of receipt. � Name, strength and dosage of medicine. � Quantity received. � The individual for whom medication is prescribed or
purchased. � Signature of the member of staff receiving the
medicines. At any given time the home should be able to identify the medicines prescribed for each individual. On admission, written confirmation of
the medicine an individual is taking should be obtained from an authoritative source. The home may find it useful to record requests for prescriptions on behalf of a service user. This will allow the
home to ensure that all items ordered have been received and that no inadvertent changes to the medication have been made.
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Monitored Dosage Systems (MDS)
There is an increasing use of monitored dosage systems (MDS) within care homes. The community pharmacist, in conjunction with
the care home manager, should assess the overall needs of the care home and its service users when deciding how the medicines should be dispensed.
This would include the possible waste of drugs and the implications associated with altering drug prescriptions and dosages (such as updating computer treatment records), before deciding
whether or not to use a monitored dosage system. It should be explained to home managers that these systems are only suitable
for some medicines. The expiry date of medicines repacked by the pharmacist into an MDS will be affected, therefore they
should not be used for ‘as required’ medication as this could lead to increased wastage. The pharmacist should seek guidance from the
medicine manufacturer about the suitability of including the medicine in an MDS. For medicines that are suitable for inclusion in an MDS, the pharmacist seals each dose of tablet(s) or capsule(s) into a separate compartment in the dosage system depending on
the dosage regimen required for the individual service user. There are several types of these systems available and the pharmacist should assess the needs of the service user and the staff in the
home before supplying medicines in such systems. Tablets or capsules, which cannot be identified and readily distinguished from each other, should not be placed together in a monitored dosage system. Labelling should enable identification of individual
medicines to be made.
Disposal of Medicines
From 01 April 2005 a new NHS contract for community pharmacists was introduced. This highlighted that community pharmacists cannot accept medication waste from care homes (nursing) unless
their pharmacy holds a Waste Management Licence. This change does not apply to care homes offering personal care only. Disposal of waste is subject to legislation and regulated by the Environment
Agency. Implications for the Care Home (Nursing)
National Minimum Standards require registered providers to have a suitable and safe system to dispose of
unwanted medication within a reasonable time, including:
� Medication remaining after a service user has died; � Medication that has been stopped by the prescriber;
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� Refused doses of medication; and
� Medication that has gone beyond the 'use by' date.
A care home (nursing) is required to safely dispose of clinical waste from the premises. It will now be necessary for the care home to make arrangements for the collection
of waste medication as well as other clinical waste products with a licensed waste disposal company. This will incur a direct cost to the care home (nursing). Disposal of medicines on site through the
sewage system is not appropriate.
Care homes (nursing) may be faced with problems as a result of the new contractual framework for community pharmacy having
highlighted the prohibition in the waste legislation of pharmacists accepting waste, and particularly if they are faced with financing a
process that was previously provided free through the local PCT For those care homes that use MDS, any tablets/capsules that have not been administered to service users should not be returned to the pharmacy with the equipment. The care home procedures must
ensure that the remaining doses are removed to a CinBin or similar. The waste disposal company will advise accordingly.
Safely administering medication
There is a requirement for care homes to provide written policies and procedures for staff administering medication.
Medicines must never be used for social control or punishment. The care home owner or manager might appoint another member of
staff to be the designated person' to look after the medicines when individuals are unable to manage their own medicines. Designated persons and members of staff involved with medicines should be appropriately trained and
assessed as competent to undertake this role. The supplying pharmacist or dispensing doctor should know, and be known by, the manager or the appointed 'designated person' in a care home
The times of administering medication are essential and there are often set times. It would be desirable if the individual were brought
to the medical/designated room rather than medication taken to them. However, it must be recognised that this is not always
acceptable and appropriate and can be classed as institutionalisation. Notable exceptions include:
� If administered in a homely setting (i.e. in a private
dwelling in the community) this will not be appropriate.
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� Where service users require their medication with food.
� Other situations e.g. service users in wheelchairs or ill in bed.
� Occasions when flexibility is required to suit local and individual needs e.g. if on an outing.
There is a need for managers and all staff to recognise the pressure on staff and this can affect the administration of medication. There is a need to be clear about the names of medication as the
brand name and the generic name can be different. If there is any confusion staff must check before administering. If in doubt do not
administer but take advice immediately.
Medicines must be prepared from the original labelled container at the point of administration and not pre-prepared except in special
circumstances. Tablets and medications must not be handled, although it is recognised that often service users will handle tablets. You must check that medication has been taken and swallowed. If
not taken, a record must be made on an individual’s file. If an individual refuses their medication then there may well be circumstances that require immediate confirmation (e.g. GP advice)
but this is by no means the accepted normality. You must identify those service users where this will apply and provide specific guidance about reasonable actions in these cases. Individuals may elect to refuse medication and this will not normally be referred to
the GP at every refusal.
Staff to sign or initial to say the correct person had the correct medication and amount at the correct time. Taking physiological measurements prior to administering
medication.
There are occasions when, prior to administering medication, you may need to take physiological measurements, for example blood pressure or to check blood glucose levels. Someone who has diabetes might need monitoring
by urine tests or blood glucose monitoring and their medication might be changed according to
the results, however this may not be the case for all diabetics. The same applies with digoxin a tablet for irregular heart beat - in some cases the individual’s pulse might be taken prior to them taking the tablet.
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With regard to blood pressure if someone’s blood pressure is
unstable then it might be necessary to monitor this if their medication is being changed.
Refusal to Take Medication
If an individual refuses their medication, verbal encouragement should be used, offer the
medication again to the person as soon as possible. If they still refuse then record listed code on the MARS sheet and record the incident in the service user’s case file. If necessary inform carers/relatives
as soon as possible. No double doses should ever be given e.g. if an individual refuses
one dose do not give two doses the next time round. The MARS sheet can be used to include PRN medications using appropriate code if it is offered and refused and record comments.
If medication is dropped on the floor or wasted this must be recorded and advice taken e.g. from GP or pharmacist on the affect
of not taking If mistakes are made then advice must be sought immediately from GP or pharmacist, particularly if
medication is missed or a double dose is accidentally given.
All staff involved in the medication error should submit a written statement immediately as to their understanding of the incident.
These statements must be from: -
� The person making the error. � The person reporting the error. � The unit manager on duty. � The report of the incident must immediately be
presented to the appropriate line manager for action.
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Checklist For An Error or Incident in the Administration of Medicines
Organisation
Name of Service User………………………………………………………………….. Name of Staff Member……………………………………………………………
Names of any Witnesses……………………………………………………………….
……………………………………………………………………………………………. Date of error/incident………………………. Date reported …………………………
Briefly describe what happened………………………………………………………. …………………………………………………………………………………………….
Date & time emergency advice sought/from who?………………………………….. What action was taken?………………………………………………………………….
……………………………………………………………………………………………… Have the details been entered into: - The organisation report/ incident book? Yes/No Date………………………. The service user’s case notes? Yes/No Date……………………….
Has the Medication Administration Record been amended? Yes/No Has the service user’s next of kin been informed? Yes/No Date……………..
Have you informed your Resource Manager? Yes/No Date…………………….. Have you completed CSCI Incident Form? Yes/No Date………………………..
What action has been agreed?………………………………………………………… Signature ………………………………………………………Date……………………
Recording and passing on information
It is recommended that one person take responsibility for writing
the medication charts as appropriate. Ideally this should be a senior member of staff.
The areas that need to be covered in the written policies are all aspects of how medicines are managed in the care home. In addition to covering procedures such as obtaining, storing and recording medicines, the policy should incorporate any specialist
procedures involving medicines relevant to that home, e.g. administration of PEG feeds/nutritional supplements.
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The home must have a policy in place so that they can identify
which members of staff have signed the MAR (Medication Administration Record) Chart following the
administration of a medicine. The home must also have a written policy for the action
to be taken if a medicine administration error is identified. The registered person must be responsible for ensuring the
appropriate maintenance of records and the manner in which records will be kept. The standard of record keeping should ensure
that records are properly completed, legible and current, providing a complete audit trail of medication. The style or manner of record
is for the home to determine, although the supplying pharmacist or dispensing doctor may be able to advise. All charts should be
referenced back to the original prescription and not the previous chart. The care home must retain an up to date reference of current medication prescribed for each person.
The care home owner and / or care home manager will have the overall responsibility for the home.
The medicine administration record chart (MAR chart) is the working document, which is signed to record administration of medicines. The MAR chart should include all prescribed medicines. This may also be used to record other medicines administered e.g. non-
prescription medicines. The chart must be dated when the medicines are administered.
The signature of the person administering the medicine must be linked to a specific medicine. This is to facilitate audits at a later date and to ensure that the records are clear. It is essential that the
person who administers the medicine refers to the record chart at the time of administration. Although it is not part of a GP contract to sign the
MAR chart, it would be considered an element of good practice, particularly for changes to doses or discontinuation of medicines. In the case of hand-
written charts not checked by the GP, it is strongly recommended that these be checked by a second person and referenced back to
the original prescription. There is no legal impediment to a care home constructing a hand-written MAR chart but there is the potential for error when charts are regularly re-written by care staff.
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The GP should ideally have the medical notes (hand-written or
electronic) accessible at the time of a visit, to enable changes to be made directly, to ease communication
links and smooth the processes of generating the future prescription. The record of medicines taken, including common or homely remedies, should be made available to the general medical practitioner whenever s/he sees the service user. The GP should also be informed when the individual does not take the medicines that are prescribed.
It is a legal requirement for care home records to be retained within
the home even when an individual has left the home. It is recommended that these records be retained for a minimum of
three years from the date of last entry, and should be retrievable if needed. In the case of children’s homes, medicine records must
normally be kept for at least fifteen years from the date of the last entry.
Administration by Self-Administration
Some individuals wish to, and are able to, administer their own medication and keep it themselves. They may choose to do this. In
all cases of self medication, it is essential that a risk assessment is carried out, at point of referral, to ascertain the ability of the individual to self medicate and to identify and eliminate any risk to themselves or to others. The record of the risk assessment is to be
kept on the individual’s file.
Also, when medication is self administered, agreement needs to be made with the individual that they will take responsibility over the administration and storage of their own medication. This should be in writing.
Ideally, the individual must be supervised, but in all circumstances managers must monitor to ensure individuals are self-medicating correctly.
A record should be maintained of the risk assessment, outcomes and of medicines given to a self-administering individual, including the date and signature of the responsible care worker. This
information will assist staff to monitor compliance with therapy. A self-administering person does not need to complete a medicine
administration record chart (MAR chart).
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Printed Medicine Administration Record (MAR) Charts
The community pharmacist may supply printed MAR charts. This is
an additional service, which is not remunerated by the NHS. The chart will usually be constructed from the same software as the product label; but is subject to the
limitations of communication and can only be accurate when there is adequate communication between the prescriber, care home and pharmacist. Pharmacists have a duty to ensure that the information printed on the MAR that they
produce is correct.
If a community pharmacist agrees to produce printed MAR charts via their computer system, the charts may only be able to include
the items that the pharmacy has dispensed for that individual in the home. The choice of whether the home wishes to use these MAR
charts or whether they wish to produce their own should be decided by the care home manager after the consideration of all the relevant issues. Residential special schools and large children’s homes where the service users are prescribed medicines on a
regular basis may find printed MAR charts beneficial. However, in the majority of children’s homes, prescribed medicines will be obtained an irregular basis when the child is ill. In these
circumstances, printed MAR charts may not be the most suitable form of record keeping. Care staff must not tamper with prescribed packs of medicines for
example by mixing batches of medicines, as this may lead to potential for claims under product liability law. Pharmaceutical
preparations should not be decanted from one container to another for the purposes of storage. This applies to medications that remain from the current supply when the new supply is received; the original supply should be finished first. The care home must take
precautions that the stock levels of medication for each service user are kept at an appropriate level dependent upon need. The Royal Pharmaceutical Society of Great Britain (RPSGB)
recognises that service users in homes may have to accept a certain restriction of freedom of choice as to where their prescriptions are dispensed. The Society
recommends that the person in charge of the care home should select one pharmacy where the home
obtains medicines on behalf of its service users in order to ensure continuity of care. The supplier of medicines, which may be a registered pharmacy or dispensing doctor, should be able to provide a timely and responsive service.
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The care home owner or manager must make a decision as to which
supplier is best able to meet the needs of the home and service users.
Consideration of the services and accessibility should be made before using that pharmacy for the supply of medication and advice to the home. Some pharmacies may undertake services that are not
included in the NHS contract such as delivery, supply of a Monitored Dosage System (MDS) device and staff training.
DID YOU KNOW?
The name for Oz in “The Wizard of Oz” was thought up when the creator, Frank
Baum, looked at his filing cabinet and saw A-N, and O-Z, hence “Oz”.
ACTIVITY THREE
Circle the words or phrases you would associate with recording information
USA MAR Medicines
Printed Africa Records
Maintained Administration Europe
UNIT ASM 34: SIGN-OFF
Assessor’s Name: _________________________________
Assessor’s Signature:_________________________Date:___________
Learner’s Name: __________________________________
Learner’s Signature:_________________Date:___________
Mentor’s Name: ________________________________
Mentor’s Signature: _________________Date:___________
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UNIT ASM 34: ASSESSMENT
ASSESSMENT ONE
Identify current legislation, guidelines policies and protocols
relevant to the administration of medication
ASSESSMENT TWO
Describe common types of medication including their effects and potential side effects
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ASSESSMENT THREE
Identify medication which demands the measurement of
specific physiological measurements
ASSESSMENT FOUR
Describe the common adverse reactions to medication, how
each can be recognised and the appropriate action(s)
required
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ASSESSMENT FIVE
Explain the different routes of medicine administration
ASSESSMENT SIX
Explain the types, purpose and function of materials and
equipment needed for the administration of medication via
the different routes
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ASSESSMENT SEVEN
Identify the required information from prescriptions /
medication administration charts
ASSESSMENT EIGHT
Explain how to apply standard precautions for infection
control
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ASSESSMENT NINE
Explain the appropriate timing of medication e.g. check that
the individual has not taken any medication recently
ASSESSMENT TEN
Explain how to obtain the individuals consent and offer
information, support and reassurance throughout, in a
manner which encourages their co-operation and which is
appropriate to their needs and concerns
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ASSESSMENT ELEVEN
Explain how to select, check and prepare correctly the
medication according to the medication administration
record or medication information leaflet
ASSESSMENT TWELVE
Explain how to select the route for the administration of
medication, according to the patient’s plan of care and the
drug to be administered, and prepare the site if necessary
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ASSESSMENT THIRTEEN
Explain how to safely administer the medication
(a) in line with legislation and local policies
(b) in a way which minimises pain, discomfort and trauma
to the individual
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ASSESSMENT FOURTEEN
Describe how to report any immediate problems with the
administration
ASSESSMENT FIFTEEN
Explain how to monitor the individual’s condition
throughout, recognise any adverse effects and take the
appropriate action without delay
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ASSESSMENT SIXTEEN
Explain why it may be necessary to confirm that the
individual actually takes the medication and does not pass
the medication to others
ASSESSMENT SEVENTEEN
Explain how to maintain the security of medication and
related records throughout the process and return them to
the correct place for storage
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ASSESSMENT EIGHTEEN
Describe how to dispose of out of date and part-used
medications in accordance with legal and organisational
requirements
UNIT ASM 34 : ASSESSMENT SIGN-OFF
Assessor’s Name: _________________________________
Assessor’s Signature:________________Date:___________
Learner’s Name: __________________________________
Learner’s
Signature:_________________________Date:___________
Mentor’s Name: ___________________________________
Mentor’s Signature:_________________Date:___________
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